Tobacco companies diversify into ‘pharmaceuticals’

(Reuters Health) - Tobacco companies claim to be developing and
selling merchandise to help cigarette smokers quit, but health
researchers accuse the industry of trying to hook consumers on
different – still dangerous – nicotine products.

Writing in Annals of Internal Medicine, researchers at the
University of California, San Francisco (UCSF) call the
industry’s push into the smoking-cessation market “the
pharmaceuticalization of the tobacco industry.”

“The same hand that’s creating the problem is attempting to
create the solution,” lead author Yogi Hendlin said in a phone
interview. “But their solution is long-term nicotine maintenance,
rather than total tobacco cessation.”

Marketing tobacco-industry merchandise as pharmaceutical products
and devices threatens to endanger public health and to derail
decades of progress in educating the public about the risks of
smoking, his team's opinion piece says.

“Tobacco companies see their future as pharmaceutical companies.
They’ve already begun to acquire pharmaceutical subsidiaries, and
they’re producing tobacco products that look and feel like
medicines,” senior author Dr. Pamela Ling, a professor of
medicine at UCSF, said in a phone interview.

The authors define “pharmaceuticalization” as the tobacco
industry’s “actual and perceived transition into a
pharmaceutical-like industry through the manufacture and sale of
noncombustible tobacco and nicotine products for smoking
cessation or long-term nicotine maintenance without the testing
and oversight required of traditional pharmaceutical products.”

The effort confuses consumers, complicates the regulatory process
and legitimizes the tobacco industry as a healthcare partner,
they say.

In response, Philip Morris International told Reuters Health in a
statement that it understood that some might question its
motives.

“At the same time we are very encouraged by the growing number of
experts and health authorities who believe that tobacco companies
like us have a key role to play in reducing the harm caused by
smoking,” the statement said.

“We are making significant efforts so that all those who would
otherwise continue smoking switch to scientifically substantiated
smoke-free alternatives as soon as possible,” it said. “We do not
ask to be trusted but to be judged based on facts.”

Ling, Hendlin and their coauthor Jesse Elias say the
pharmaceuticalization of tobacco relies on two false assumptions:
substantial numbers of smokers cannot quit, and the only way most
smokers could quit would be with the help of pharmacotherapy.

As many as 90 percent of smokers who stop smoking do so cold
turkey, without cessation aids, said Hendlin, a postdoctoral
fellow at UCSF’s Center for Tobacco Control Research and
Education.

But quitting cold turkey is easier said than done for a
substantial group of smokers, particularly smokers coping with
substance abuse and other mental health issues, said Donna
Vallone, chief research officer at Truth Initiative’s Schroeder
Institute, a Washington, D.C. nonprofit dedicated to ending youth
smoking.

“Believe me, it’s right to worry about the industry’s objectives
here,” she said by phone.

“On the other hand, we do believe that harm reduction is a
legitimate public-health strategy. When you’re a lifetime
committed smoker and you’re trying to quit, these products can be
helpful to you,” said Vallone, who was not involved in the
commentary.

All the major transnational tobacco companies have invested in
so-called pharmaceuticalized tobacco products, according to the
commentary authors.

In December, Philip Morris submitted a multimillion-page
application to the U.S. Food and Drug Administration (FDA)
seeking to certify a new product – I Quit Ordinary Smoking, or
IQOS – as having “modified risk” compared to cigarettes.

IQOS includes short, disposable tobacco sticks soaked in
propylene glycol and inserted in a heat-not-burn cigarette,
which, like e-cigarettes, exempts it from smoking laws in many
countries. A recent study in JAMA Internal Medicine found that
the product releases chemicals linked to cancer, sometimes in
higher concentrations than conventional cigarettes.

If approved by the FDA, IQOS would become the country’s first
modified-risk, or reduced-harm, tobacco product.

Smoke from IQOS cigarettes releases 84 percent of the nicotine
found in traditional cigarettes, the JAMA Internal Medicine study
found.

“While the tobacco industry seeks to glamorize, normalize and
rationalize nicotine addiction, don’t be fooled: nicotine is a
potently addictive and harmful drug,” said Mark Travers, a
researcher at the Roswell Park Cancer Institute in Buffalo, New
York.

“Our ultimate goal will always be to end tobacco use AND nicotine
addiction,” said Travers, who was not involved with the
commentary, in an email. “Yes, pharmaceutical nicotine, as
approved by the FDA, is an effective way to assist in stopping
smoking, but complete abstinence of tobacco and nicotine use is
the best outcome.”